The Tides are Shifting Once Again for Managed Care

The renewed focus on managed care underscores the importance for managed care organizations (MCOs) to focus on managing risks. Specifically, given the regulatory climate and the heightened public scrutiny on health insurance due to the Affordable Care Act, this regulatory spotlight is not likely to dim. Furthermore, regulatory requirements call for Medicare MCOs to establish and implement an effective system for routine monitoring and identification of compliance risks. It is expected that they will develop ongoing monitoring and auditing work plans and that key participants will be the compliance officer and the compliance committee.

About the Author

Rita Isnar joined Strategic Management in 2003 and is responsible for client fulfillment activities. Her in-depth knowledge and compliance experience includes managed care, Medicare Parts C & D compliance program development and implementation, government enforcement initiatives, quality of care issues and regulatory compliance.